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Roach: Painful esophageal spasm needs expert diagnosis

Dear Dr. Roach: My daughter suffers terribly from esophageal spasms. She is currently taking Ativan, Bentyl, Pepcid and sometimes Ultram. She has suffered for two years. It is unbearable, and she just wants to give up. She has two young children and a full-time job. She has burning in her shoulders that is really bad. She even had her gallbladder unnecessarily removed last year. Help! — M.V.

Diffuse esophageal spasm is an uncommon disorder in which the nerves and muscles of the esophagus act abnormally during swallowing and can cause chest pain, heartburn, regurgitation or difficulty swallowing. It’s not really clear what causes it. I do know that the pain can be extreme in some cases.

There are several treatments, but your daughter isn’t on any of the treatments that are generally accepted as effective. This may be because her doctors have tried the standard treatments and found them ineffective, or because they lack experience with this uncommon disease. It can be hard to diagnose definitively, with the “gold standard” for diagnosis being manometry, a measurement of the nerve impulses and pressures inside the esophagus, sometimes with a medication injected to see if it causes spasm. More often, physicians try treatment empirically, hoping to find an effective regimen. The most common effective treatments include calcium channel blockers like diltiazem or amlodipine, antidepressants like trazodone or imipramine (which change the way pain is perceived rather than affect the esophagus itself), and sildenafil (Viagra), which is used for several conditions besides ED. Non-pharmacologic treatments include hot water and peppermint oil. Botox injections sometimes are used, but surgery is used only rarely.

I think your daughter really needs an expert in this disorder. Gastroenterologists, who are themselves subspecialists, are not always familiar with this condition, and it may require a gastroenterologist who subsubspecializes in swallowing problems to properly diagnose and help your daughter.

DR. KEITH ROACH’S column is syndicated by North America Syndicate. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

The South Plains Electric Cooperative and CoBank will present a $10,000 check to The Inside Out Foundation at 10 a.m. Tuesday at Hub City Clays Lubbock Shooting Complex, 1475 CR 1, according to a press release from SPEC.